Provider Demographics
NPI:1619978103
Name:SAXE, SCOTT BERNARD (DPM)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:BERNARD
Last Name:SAXE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3790 117TH LN NW
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-2666
Mailing Address - Country:US
Mailing Address - Phone:763-421-7300
Mailing Address - Fax:763-421-3337
Practice Address - Street 1:650 HUEBNER RD
Practice Address - Street 2:
Practice Address - City:FORT RILEY
Practice Address - State:KS
Practice Address - Zip Code:66442-4030
Practice Address - Country:US
Practice Address - Phone:785-239-7177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN657213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2700362OtherMEDICA
MN794442000Medicaid
MN171500OtherUCARE
MN086L8SAOtherBLUE CROSS BLUE SHIELD
MN33942OtherHEALTH PARTNERS
MN480000468Medicare UPIN
MN171500OtherUCARE
MN794442000Medicaid